Provider Demographics
NPI:1083035646
Name:BAKER, TONYA (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3830 EAST GATEWAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4115
Mailing Address - Country:US
Mailing Address - Phone:602-243-7277
Mailing Address - Fax:602-286-0808
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:SUITE 4020
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-323-3393
Practice Address - Fax:602-323-3399
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ140261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical